Read Provider Update
This monthly newsletter delivers updates on policies, changes to benefits, and other news you need to know.
- P = Professional
- B = Behavioral health
- F = Facilities
BCBSRI Update
P B F
1 Jun, 2025
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
P B F
1 Jun, 2025
The latest Dual Special Needs Plan (D-SNP) Model of Care (MOC) evaluation and other performance resu...
P B F
1 de maio, 2025
To offer best-in-class services related to utilization management (UM) functions, we are pleased to ...
Provider Relations
P B F
1 Jun, 2025
BCBSRI invites providers to join us on Tuesday, 10 de junho, from 10-11 a.m. for a conference call with ...
P B F
1 Jun, 2025
Beginning 1 de junho, 2025, our Provider Call Center implemented a transaction limit of five claims.&nbs...
P F
1 de maio, 2025
At BCBSRI we continue to improve our members’ health and peace of mind by facilitating their access ...
Physician & Provider Call Center
P B F
1 de maio, 2025
Beginning 1 de junho, 2025, our Provider Call Center will implement a transaction limit of five cl...
P B F
1 Jul, 2023
As a reminder, there is a functionality on the BCBSRI Provider Portal that allows providers to send ...
P B F
1 Jun, 2021
Did you know our secured Physician and Provider Portal offers the following: •Check me...
Quality
P
1 Jun, 2025
The Medicare Health Outcomes Survey (HOS) will be mailed to members beginning in July and through No...
P
1 Abr, 2025
The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool developed by the National Co...
P
1 Mar, 2025
The Centers for Medicare and Medicaid Services (CMS) has introduced two new Part D Star Measures for...
Behavioral Health
P B
1 Jun, 2025
BCBSRI has collaborated with providers throughout Rhode Island to ensure that our members have acces...
P B
1 Jun, 2025
The BCBSRI Behavioral Health Case Management program is staffed by experienced mental health and sub...
B
1 Jun, 2025
Across the world, more than 55 million people are living with Alzheimer’s disease or another form of...
Farmácia
P B F
1 Jun, 2025
Large Group and Small Group Markets Formulary The information below is effective as of 1 de julho, ...
P F
1 Abr, 2025
The following drugs will require PA effective 4/1/25...
P B F
1 Mar, 2025
Large Group and Small Group Markets FormularyThe information below is effective as of 1 de abril, 2025,...
Products & Benefits
P B F
1 Dez, 2019
In the large group portfolio, we will also be adding eight Network Blue New England Options plans, a...
P B F
1 Dez, 2019
Our regional BlueCHiP family is expanding in the small group market with Effective 1 de janeiro, 2020, ...
P B F
1 Dez, 2019
Effective 1 de janeiro, 2020, BCBSRI will become the insurer for all Lifespan employees. Below is a qui...
Reivindicações
P B F
1 Abr, 2024
BCBSRI is not a PPO network sharing plan. We are not allowed to price based on our participating pro...
P B F
1 Jan, 2024
BCBSRI claims department has seen an increase in claims rejecting for no eligibility because claims ...
P B F
1 Nov, 2023
If you are correcting a claim due to an audit finding, you must submit Medical Records with your cor...
Policies
P F
10 Jun, 2025
We have completed our review of the 20 de julho25 CPT code changes, including any category II performanc...
P F
9 Jun, 2025
We have completed our review of the 20 de julho25 Healthcare Common Procedure Coding System (HCPCS) chan...
P F
4 Jun, 2025
This is a newly created payment policy which will go into effect on 4 de agosto, 2025. This new policy ...